Health visitors and school nurses’ new curriculum reflects range and breadth of role

Nick Evans

Posted 18 April 2019 - 12:00

Rapid changes in the roles of health visitors and school nurses are recognised in a new curriculum that sets out the knowledge, skills and attributes they need

Rapid changes in the roles of health visitors and school nurses are recognised in a new curriculum that sets out the knowledge, skills and attributes they need

Picture: SPL

Health visitors and school nurses fulfil a unique role in the NHS, illustrated by the fact that they have their own place on the nursing register. The specialist community public health nursing (SCPHN) category requires nurses to undergo extra training to achieve the standards of practice set out by the Nursing and Midwifery Council.

But the demands of the role are changing rapidly. In response, six leading health organisations have set out a recommended curriculum for SCPHN training.

The 44-page document is the result of more than two years of work by a stakeholder group coordinated by the Institute of Health Visiting and involving the trade union Unite, the National Forum of School Health Educators, the UK Standing Conference on SCPHN Education, the School and Public Health Nurses Association and the Royal College of Nursing.

The curriculum sets out the knowledge, skills and attributes a modern health visitor or school nurse needs to gain from the practical and theoretical elements of training. The range and breadth is huge.

What the curriculum says training should do

Provide nurses with knowledge of:

Human development, including nutrition, genetics, and social and emotional aspects of all life stages from prenatal to college age

How to implement as well as generate reliable and valid evidence through audit, evaluation and empirical research

Strong leadership and know-how to champion service quality, stimulate innovation and support change

Technology to support service delivery and care planning

Decision-making and assessment needed to diagnose and take action

Hone skills already developed and add to them so they have:

Flexibility to shift the focus between a patient’s different family members and their health needs

Ability to build relationships of trust

Empathetic communication

Good interviewing, listening and questioning skills

Ability to negotiate, find solutions and resolve conflict

Advocacy skills to give children and young people a voice

Facilitate ways of acquiring, developing and evidencing these attributes:

Cultural humility and awareness

Self-reflection and awareness

Able to promote health and well-being in a way that builds on individual’s own assets, potential and attributes

Able to do work patterns not based on routine and be responsive to emerging needs

Strong sense of professional identity given the need to work across boundaries.

Unique challenges

Curriculum lead author Robert Nettleton is unapologetic about the ambition, saying the document demonstrates the ‘complexities and subtleties’ of these roles.

Dr Nettleton believes the roles are different from many nursing jobs, pointing out that they do not have ‘pre-selected’ patients as many do and face unique challenges, whether it is ‘negotiating to get into schools’ or dealing with local authority services, child safeguarding teams and mental health services alongside primary and secondary care.

He says the curriculum purposely falls short of a full syllabus, as that would have been ‘too complex’ given the variation in services between the devolved nations and, increasingly, local areas in England. Instead, he hopes it gives a broad idea of what is needed based on the most recent evidence and professional consensus.

Flexibility in training

The curriculum acknowledges it is commonplace for modules to be shared with other courses. Of the 24 courses analysed, all shared at least half their modules, most commonly with students on the community specialist practitioner course for district nurses, general practice nurses and community children’s nurses.

The modules shared tended to be on research, leadership, safeguarding, child development and health promotion.

This is understandable, but Dr Nettleton says there is a need for flexibility in SCPHN training to respond to the ‘pace and speed of emerging models of delivery’ as well as the introduction of apprenticeship programmes, which may be extended to this field.

Broad relevance

What happens next? He hopes education providers will use the curriculum to review courses and says the Institute of Health Visiting will be building on the work by showcasing best practice.

He also wants the NMC to use it as the regulator reviews the standards of proficiency for SCPHN, which set out what nurses must achieve to be placed on this section of the register. The regulator has confirmed it will do so.

Dr Nettleton hopes the effect will stretch beyond this. ‘We see the curriculum as being targeted at everyone. It can help those thinking about studying – they don’t always know what it entails – and it can help those who are working to articulate what the role involves and what they need from their employers. It has a broad relevance.’

The view of the workforce

Sharon White

School and Public Health Nurses Association chief executive Sharon White says the new document is much needed.

‘It’s the first time we have had a curriculum like this. Education providers have been left to develop their own courses, and that has meant there has been a huge amount of variation and standards.’

She hopes it will help set a bar to protect the workforce given recent cuts – over the past three years health visitor numbers have been cut by 24% and school nurses by 6% in terms of full-time equivalents.

‘There are all sorts of new posts and roles being developed, driven by the need to make savings. We’re concerned that the skills mix is being diluted too much in some places – with nursery nurses and staff nurses being asked to take on complex care they should not.’

She cites what she describes as random models, with health visitors taking on primary responsibility for children up to the age of seven and generic adolescent health teams developed to act as a substitute for school nurses.

‘We are not against innovation. But we have to be careful that innovation is not taken too far to simply make savings’

View of the educator

Joy Murray

University of the West of England senior lecturer and SCPHN programme leader Joy Murray says education providers welcome the publication and will be looking to map their courses against it.

Ms Murray, who until recently was chair of the UK Standing Conference on SCPHN Education, says it importantly recognises the need for a more flexible workforce.

‘There is much more focus on a more seamless service for ages 0 to 19. There is a view that when there is an older child in the family who a health visitor has contact with, why shouldn’t the health visitor offer support, and vice versa for school nurses.

‘If we are going to have a more flexible workforce we need to make sure they have the necessary skills, and this curriculum reflects what is needed to achieve that and what the latest evidence says. The evidence we had was somewhat out of date.’

She says that while the rationale is good, there must be a degree of caution that this shift is not used as a cover for cuts. ‘The workforce is in a bit of a crisis at the moment.’